Anthropometric measurements and body silhouette of women: validity and perception

Overweight and obesity: prediction by silhouettes in young adults

The present study analyzes the prevalence of overweight/obesity in a sample of young adults from the University of the Basque Country (Spain), and tests the efficiency of the silhouettes to predict overweight/obesity. This cross-sectional study was conducted in a sample of volunteer university students from the University of the Basque Country (356 men and 745 women, age: 18-33 years), who came to the Physical Anthropology laboratory where a standardized questionnaire was administered and anthropometric measurements were taken by a well-trained anthropometrist. Height and weight were obtained. BMI was calculated as weight/height(2) (kg/m(2)) and it was used as a reference method. Using a questionnaire, based on the standard figural stimuli, subjects were asked to choose the silhouette which was closest to his/her usual appearance (current body size). The accuracy of the Williamson et al.'s silhouettes as an overweight-obesity indicator was analyzed by gender-specific receiver operating curve (ROC). The cutoff figure to distinguish between nonoverweight and overweight-obese individuals corresponded to number 7 in men and 6 in women. These cutoff values matched optimal sensitivity and specificity, with few nonoverweight subjects selecting silhouettes bigger than 7 in the case of men or 6 for women. In conclusion, the figural stimuli allows the identification of populations at overweight/obesity risk with the simple use of silhouettes, at least in this rank of age, where the overweight and obesity are yet little frequent.

Proteins, dietary acid load, and calcium and risk of postmenopausal fractures in the E3N French women prospective study

Excess dietary proteins and "acid ash" diets have been suspected to increase the risk of osteoporosis, but experimental and epidemiological evidence is mixed. We aimed to determine whether the association between protein intake and the overall acid-base equilibrium of the diet (as renal net acid excretion [RNAE] estimate) and fracture risk vary according to calcium intake. During an average of 8.37 +/- 1.73 yr of follow-up, 2408 women reported a fracture (excluding high-impact trauma) among 36,217 postmenopausal women from the E3N prospective study. We used Cox regression models to study the interaction between calcium and, respectively, proteins and RNAE, from the 1993 dietary questionnaire for fracture risk determination, adjusting for potential confounders. There was no overall association between fracture risk and total protein or RNAE. However, in the lowest quartile of calcium (<400 mg/1000 kcal), high protein intake was associated with a significant increased fracture risk (RR = 1.51 for highest versus lowest quartile; 95% CI, 1.17-1.94). An increasing fracture risk with increasing animal protein intake was also observed (trend, p < 0.0001). A similar pattern of interaction for fracture risk was observed between RNAE and calcium. In this Western population of postmenopausal women with normal to high protein intake and fairly high calcium intake, there was no overall association between total protein or RNAE and fracture risk. However, there was some evidence that high protein-high acid ash diets were associated with an increased risk of fracture when calcium intake was low (<400 mg/1000 kcal).

Accuracy of self-reported body weight, height and waist circumference in a Dutch overweight working population

Background

In population studies, body mass index (BMI) is generally calculated from self-reported body weight and height. The self-report of these anthropometrics is known to be biased, resulting in a misclassification of BMI status. The aim of our study is to evaluate the accuracy of self-reported weight, height and waist circumference among a Dutch overweight (Body Mass Index [BMI] ≥ 25 kg/m²) working population, and to determine to what extent the accuracy was moderated by sex, age, BMI, socio-economic status (SES) and health-related factors.

Methods

Both measured and self-reported body weight and body height were collected in 1298 healthy overweight employees (66.6% male; mean age 43.9 ± 8.6 years; mean BMI 29.5 ± 3.4 kg/m²), taking part in the ALIFE@Work project. Measured and self-reported waist circumferences (WC) were available for a sub-group of 250 overweight subjects (70.4% male; mean age 44.1 ± 9.2 years; mean BMI 29.6 ± 3.0 kg/m²). Intra Class Correlation (ICC), Cohen's kappa and Bland Altman plots were used for reliability analyses, while linear regression analyses were performed to assess the factors that were (independently) associated with the reliability.

Results

Body weight was significantly (p < 0.001) under-reported on average by 1.4 kg and height significantly (p < 0.001) over-reported by 0.7 cm. Consequently, BMI was significantly (p < 0.001) under-reported by 0.7 kg/m². WC was significantly (p < 0.001) over-reported by 1.1 cm. Although the self-reporting of anthropometrics was biased, ICC's showed high concordance between measured and self-reported values. Also, substantial agreement existed between the prevalences of BMI status and increased WC based on measured and self-reported data. The under-reporting of BMI and body weight was significantly (p < 0.05) affected by measured weight, height, SES and smoking status, and the over-reporting of WC by age, sex and measured WC.

Conclusion

Results suggest that self-reported BMI and WC are satisfactorily accurate for the assessment of the prevalence of overweight/obesity and increased WC in a middle-aged overweight working population. As the accuracy of self-reported anthropometrics is affected by measured weight, height, WC, smoking status and/or SES, results for these subgroups should be interpreted with caution. Due to the large power of our study, the clinical significance of our statistical significant findings may be limited.

Trial Registration

ISRCTN04265725

"Oriental anthropometry" in plastic surgery

BACKGROUND

According to Chinese medicine, the acupuncture-points' (acupoints) locations are proportionally and symmetrically distributed in well-defined compartment zones on the human body surface Oriental Anthropometry" (OA). Acupoints, if considered as aesthetic-loci, might be useful as reference guides in plastic surgery (PS).

AIM

This study aimed to use aesthetic-loci as anatomical reference in surgical marking of Aesthetic Plastic Surgery.

METHOD

This was an observational study based on aesthetic surgeries performed in private clinic. This study was based on 106 cases, comprising of 102 women and 4 men, with ages varying from 07 to 73 years, and with heights of between 1.34 m and 1.80 m. Patients were submitted to aesthetic surgical planning by relating aesthetic-loci to conventional surgical marking, including breast surgeries, abdominoplasty, rhytidoplasty, blepharoplasty, and hair implant. The aesthetic-surgical-outcome (ASO) of the patients was assessed by a team of plastic surgeons (who were not involved in the surgical procedures) over a follow-up period of one year by using a numeric-rating-scale in percentage (%) terms. A four-point-verbal-rating-scale was used to record the patients' opinion of therapeutic-satisfaction (TS).

RESULTS

ASO was 75.3 +/- 9.4% and TS indicated that most patients (58.5%) obtained "good" results. Of the remainder, 38.7% found the results "excellent", and 2.8% found them "fair".

DISCUSSION AND CONCLUSION

The data suggested that the use of aesthetic-loci may be a useful tool for PS as an anatomical reference for surgical marking. However, further investigation is required to assess the efficacy of the OA by providing the patients more reliable balance and harmony in facial and body contours surgeries.

Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women

BACKGROUND

Diets high in carbohydrates may result in chronically elevated insulin concentrations and may affect breast cancer risk by stimulation of insulin receptors or through insulin-like growth factor I (IGF-I)-mediated mitogenesis. Insulin response to carbohydrate intake is increased in insulin-resistant states such as obesity.

OBJECTIVE

We sought to evaluate carbohydrate intake, glycemic index (GI), and glycemic load (GL) and subsequent overall and hormone-receptor-defined breast cancer risk among postmenopausal women.

DESIGN

A prospective cohort analysis of dietary carbohydrate and fiber intakes was conducted among 62 739 postmenopausal women from the E3N French study who had completed a validated dietary history questionnaire in 1993. During a 9-y period, 1812 cases of pathology-confirmed breast cancer were documented through follow-up questionnaires. Nutrients were categorized into quartiles and energy-adjusted with the regression-residual method. Cox model-derived relative risks (RRs) were adjusted for known determinants in breast cancer.

RESULTS

Dietary carbohydrate and fiber intakes were not associated with overall breast cancer risk. Among overweight women, we observed an association between GI and breast cancer (RR(Q1-Q4): 1.35; 95% CI: 1.00, 1.82; P for trend = 0.04). For women in the highest category of waist circumference, the RR(Q1-Q4) was 1.28 (95% CI: 0.98, 1.67; P for trend = 0.10) for carbohydrates, 1.35 (95% CI: 1.04, 1.75; P for trend = 0.01) for GI, and 1.37 (95% CI: 1.05, 1.77; P for trend = 0.003) for GL. We also observed a direct association between carbohydrate intake, GL, and estrogen receptor-negative breast cancer risk.

CONCLUSIONS

Rapidly absorbed carbohydrates are associated with postmenopausal breast cancer risk among overweight women and women with large waist circumference. Carbohydrate intake may also be associated with estrogen receptor-negative breast cancer.

Comparison of self-reported and measured height and weight: implications for obesity research among young adults

BACKGROUND

The use of self-reported data in epidemiological surveys leads to misclassification of the prevalence of obesity as the participants overestimate or underestimate height, weight and/or both. Such misclassifications vary according to gender, age, status and ethnicity.

OBJECTIVES

To estimate on a sample of youth of both sexes (1) the difference between self-reported data and measured height and weight and (2) the extent of misclassification of BMI deriving from such differences.

METHODS

Self-reporting in questionnaires and subsequent measurements of height and weight conducted by trained personnel. The mean values and the BMIs were calculated.

RESULTS

Both sexes overestimate height (2.1 and 2.8cm for males and females, respectively), and underestimate weight (1.5 and 1.9kg for males and females, respectively). Consequently the BMI is underestimated (1.1 and 1.5 points for males and females, respectively). The classification of BMI from self-reported data shows underestimation of overweight in both sexes (8 percentage points) and of obese males (3.3 percentage points), an overestimation of normal weight (12.2 and 4.3 percentage points for males and females, respectively) and an excessive underweight in the girls (4.3 percentage points).

CONCLUSIONS

There is a difference between self-reported and measured data and self-reported biases are reflected in the classification of the participants in the 4 categories of BMI.

Hormone replacement therapy use and plasma levels of sex hormones in the Norwegian Women and Cancer postgenome cohort - a cross-sectional analysis

Background

Hormone replacement therapy use (HRT) is associated with increased breast cancer risk. Our primary objective was to explore hormone levels in plasma according to HRT use, body mass index (BMI) and menopausal status. A secondary objective was to validate self-reported questionnaire information on menstruation and HRT use in the Norwegian Women and Cancer postgenome cohort (NOWAC).

Methods

We conducted a cross-sectional study of sex hormone levels among 445 women aged 48–62 who answered an eight-page questionnaire in 2004 and agreed to donate a blood sample. The samples were drawn at the women's local general physician's offices in the spring of 2005 and sent by mail to NOWAC, Tromsø, together with a two-page questionnaire. Plasma levels of sex hormones and Sex Hormone Binding Globulin (SHBG) were measured by immunometry. 20 samples were excluded, leaving 425 hormone measurements.

Results

20% of postmenopausal women were HRT users. The plasma levels of estradiol (E₂) increased with an increased E₂ dose, and use of systemic E₂-containing HRT suppressed the level of Follicle Stimulating Hormone (FSH). SHBG levels increased mainly among users of oral E₂ preparations. Vaginal E₂ application did not influence hormone levels. There was no difference in BMI between HRT users and non-users. Increased BMI was associated with increased E₂ and decreased FSH and SHBG levels among non-users. Menopausal status defined by the two-page questionnaire showed 92% sensitivity (95% CI 89–96%) and 73% specificity (95% CI 64–82%), while the eight-page questionnaire showed 88% sensitivity (95% CI 84–92%) and 87% specificity (95% CI 80–94%). Current HRT use showed 100% specificity and 88% of the HRT-users had plasma E₂ levels above the 95% CI of non-users.

Conclusion

Users of systemic E₂-containing HRT preparations have plasma E₂ and FSH levels comparable to premenopausal women. BMI has an influence on hormone levels among non-users. NOWAC questionnaires provide valid information on current HRT use and menopausal status among Norwegian women who are between 48 and 62 years old.

A longitudinal study of infant feeding and obesity throughout life course

BACKGROUND

The Centers for Disease Control and Prevention and the US Department of Health and Human Services promote breastfeeding as a strategy for reducing childhood overweight. We evaluated the relation between infant feeding and the development of overweight and obesity throughout life course.

METHODS

We investigated the association between infant feeding and obesity among 35,526 participants in the Nurses' Health Study II who were followed prospectively from 1989 to 2001. Mothers of participants provided information by mailed questionnaires on the duration of breast- and bottle-feeding, as well as the type of milk or milk substitute in the bottle. Information on body shape at ages 5 and 10, weight at age 18, current weight between 1989 and 2001, and height was reported by the participants.

RESULTS

The duration of breastfeeding, including exclusive breastfeeding, was not related to being overweight (25< or = body mass index (BMI) <30 kg/m(2)) or obese (BMI> or =30 kg/m(2)) during adult life. Women who were exclusively breastfed for more than 6 months had a risk of 0.94 (95% confidence interval (CI) 0.83-1.07) of becoming obese as adults compared with women who were not breastfed. Exclusive breastfeeding for more than 6 months was associated with leaner body shape at age 5 (odds ratio (OR)=0.81; 95% CI 0.65-1.01 for the highest vs the lowest category of body shape) compared to women who were not breastfed or breastfed for less than 1 week, but this association did not persist during adolescence or adulthood.

CONCLUSIONS

We did not find that having been breastfed was associated with women's likelihood of becoming overweight or obese throughout life course. Although breastfeeding promotes the health of mother and child, it is unlikely to play an important role in controlling the obesity epidemic.

Body image and quality of life in post massive weight loss body contouring patients

OBJECTIVE

Because post-bariatric surgery patients undergo massive weight loss, the resulting skin excess can lead to both functional problems and profound dissatisfaction with appearance. Correcting skin excess could improve all these corollaries, including body image. Presently, few data are available documenting body image and weight-related quality of life in this population.

RESEARCH METHODS AND PROCEDURES

Eighteen patients who underwent both bariatric surgery and body contouring completed our study. Both established surveys and new surveys designed specifically for the study were used to assess body perception and ideals, quality of life, and mood. Patients were surveyed at the following time-points: pre-body contouring (after massive weight loss) and both 3 and 6 month post-body contouring. Statistical testing was performed using Student's t test and ANOVA.

RESULTS

The mean age of the patients was 46 +/- 10 years (standard deviation). Quality of life improved after obesity surgery and was significantly enhanced after body contouring. Three months after body contouring, subjects ascribed thinner silhouettes to both current appearance and ideal body image. Body image also improved with body contouring surgery. Mood remained stable over 6 months.

DISCUSSION

Body contouring after surgical weight loss improved both quality-of-life measurements and body image. Initial body dissatisfaction did not correlate with mood. Body contouring improved body image but produced dissatisfaction with other parts of the body, suggesting that as patients become closer to their ideal, these ideals may shift. We further developed several new assessment methods that may prove useful in understanding these post-surgical weight loss patients.

The feasibility and utility of grocery receipt analyses for dietary assessment

Objective

To establish the feasibility and utility of a simple data collection methodology for dietary assessment.

Design

Using a cross-sectional design, trained data collectors approached adults (~20 – 40 years of age) at local grocery stores and asked whether they would volunteer their grocery receipts and answer a few questions for a small stipend ($1).

Methods

The grocery data were divided into 3 categories: "fats, oils, and sweets," "processed foods," and "low-fat/low-calorie substitutions" as a percentage of the total food purchase price. The questions assessed the shopper's general eating habits (eg, fast-food consumption) and a few demographic characteristics and health aspects (eg, perception of body size).

Statistical Analyses Performed. Descriptive and analytic analyses using non-parametric tests were conducted in SAS.

Results

Forty-eight receipts and questionnaires were collected. Nearly every respondent reported eating fast food at least once per month; 27% ate out once or twice a day. Frequency of fast-food consumption was positively related to perceived body size of the respondent (p = 0.02). Overall, 30% of the food purchase price was for fats, oils, sweets, 10% was for processed foods, and almost 6% was for low-fat/low-calorie substitutions. Households where no one was perceived to be overweight spent a smaller proportion of their food budget on fats, oils, and sweets than did households where at least one person was perceived to be overweight (p = 0.10); household where the spouse was not perceived to be overweight spent less on fats, oils, and sweets (p = 0.02) and more on low-fat/low-calorie substitutions (p = 0.09) than did households where the spouse was perceived to be overweight; and, respondents who perceived themselves to be overweight spent more on processed foods than did respondents who did not perceive themselves to be overweight (p = 0.06).

Conclusion

This simple dietary assessment method, although global in nature, may be a useful indicator of dietary practices as evidenced by its association with perceived weight status.

Several anthropometric measurements and breast cancer risk: results of the E3N cohort study

OBJECTIVE

To investigate the association between various anthropometric characteristics and breast cancer.

DESIGN

Longitudinal prospective cohort study. Follow-up between 1995 and 2000.

SUBJECTS

In total, 69 116 women (age: 45-70 years; mean follow-up: 3.6 years), 275 premenopausal and 860 postmenopausal incident invasive breast cancers.

MEASUREMENTS

Self-reported height, weight, breast, thorax, waist and hip circumferences and calculated body mass index (BMI) and waist-to-hip ratio (WHR) at baseline.

RESULTS

A slight increase in risk with increasing height was found. Weight, BMI, thorax and waist circumferences and WHR were negatively related to breast cancer risk among premenopausal women. The relationships became non significant after additional adjustment for BMI. An increased risk of premenopausal breast cancer with an android body shape (WHR>0.87) might possibly be confined to obese women. Among postmenopausal women, all anthropometric measurements of corpulence were positively associated with breast cancer risk but became non significant after additional adjustment for BMI. No difference in risk of postmenopausal breast cancer according to HRT use was observed.

CONCLUSION

The study confirmed that adiposity was negatively associated to premenopausal breast cancer risk and positively associated to postmenopausal breast cancer risk. Further studies will be needed to specify clearly the association between WHR and breast cancer risk, particularly before menopause.

Loci contributing to adult height and body mass index in African American families ascertained for type 2 diabetes

Height and body mass index (BMI) have high heritability in most studies. High BMI and reduced height are well-recognized as important risk factors for a number of cardiovascular diseases. We investigated these phenotypes in African American families originally ascertained for studies of linkage with type 2 diabetes using self-reported height and weight. We conducted a genome wide scan in 221 families containing 580 individuals and 672 relative pairs of African American descent. Estimates of heritability and support for linkage were assessed by genetic variance component analyses using SOLAR software. The estimated heritabilities for height and BMI were 0.43 and 0.64, respectively. We have identified major loci contributing to variation in height on chromosomes 15 (LOD = 2.61 at 35 cM, p = 0.0004), 3 (LOD = 1.82 at 84 cM, p = 0.0029), 8 (LOD = 1.92 at 135 cM, p = 0.0024) and 17 (LOD = 1.70 at 110 cM, p = 0.0044). A broad region on chromosome 4 supported evidence of linkage to variation in BMI, with the highest LOD = 2.66 at 168 cM (p = 0.0005). Two height loci and two BMI loci appear to confirm the existence of quantitative trait loci previously identified by other studies, providing important replicative data to allow further resolution of linkage regions suitable for positional cloning of these cardiovascular disease risk loci.

Body fatness during childhood and adolescence and incidence of breast cancer in premenopausal women: a prospective cohort study

INTRODUCTION

Body mass index (BMI) during adulthood is inversely related to the incidence of premenopausal breast cancer, but the role of body fatness earlier in life is less clear. We examined prospectively the relation between body fatness during childhood and adolescence and the incidence of breast cancer in premenopausal women.

METHODS

Participants were 109,267 premenopausal women in the Nurses' Health Study II who recalled their body fatness at ages 5, 10 and 20 years using a validated 9-level figure drawing. Over 12 years of follow up, 1318 incident cases of breast cancer were identified. Cox proportional hazards regression was used to compute relative risks (RRs) and 95% confidence intervals (CIs) for body fatness at each age and for average childhood (ages 5-10 years) and adolescent (ages 10-20 years) fatness.

RESULTS

Body fatness at each age was inversely associated with premenopausal breast cancer incidence; the multivariate RRs were 0.48 (95% CI 0.35-0.55) and 0.57 (95% CI 0.39-0.83) for the most overweight compared with the most lean in childhood and adolescence, respectively (P for trend < 0.0001). The association for childhood body fatness was only slightly attenuated after adjustment for later BMI, with a multivariate RR of 0.52 (95% CI 0.38-0.71) for the most overweight compared with the most lean (P for trend = 0.001). Adjustment for menstrual cycle characteristics had little impact on the association.

CONCLUSION

Greater body fatness during childhood and adolescence is associated with reduced incidence of premenopausal breast cancer, independent of adult BMI and menstrual cycle characteristics.

Breast Reconstruction with Expanders and Implants: A Numerical Analysis

In the last few decades, breast reconstruction has evolved significantly due to improvement in surgical techniques and development of new materials. Although most authors consider that breast reconstruction using autologous tissue offers the best aesthetic results, excellent outcomes have been obtained employing silicone implants. However there is a lack of good understanding of the implications of using each type of adjustable implant on tissue dynamics and the influence on final breast shape. The aim of this research is to analyze the stresses and strains that occur in skin immediately after breast reconstruction. This simulation is performed using the finite element package ABAQUS/Explicit.

Anthropometry, breast cancer and menopausal status: Use of repeated measurements over 10 years of follow-up?results of the French E3N women's cohort study

The association between weight, BMI and breast cancer was analyzed on 94,805 women of the E3N cohort according to their menopausal status. Seven hundred eighty-six incident invasive premenopausal breast cancers and 1,522 incident invasive postmenopausal breast cancers occurred during a mean follow-up of 9.7 years. Weight and BMI were updated every 24 months and considered as time-dependent variables. Data were analyzed using multivariate Cox proportional hazards models. Trend RRs of premenopausal breast cancer were 0.97 (0.92-1.01) for a 5 kg increase in weight and 0.96 (0.91-1.01) for a 2 kg/m(2) increase in BMI, adjusted for other known risk factors. Opposite trend RRs were found after menopause: 1.05 (1.02-1.08) for weight and 1.06 (1.02-1.09) for BMI, respectively, for similar increases. Women with a BMI of over 30 kg/m(2) had a RR of premenopausal breast cancer of 0.66 (0.40-1.10) compared to those with a BMI of between 18.5 and 25 kg/m(2). Postmenopausal women with a BMI of over 30 kg/m(2) had a RR of breast cancer of 1.23 (1.00-1.59). The increase in risk of postmenopausal breast cancer with increased weight or BMI was similar whatever the HRT used, although the point estimates were higher in HRT users. We strongly recommend to use anthropometric measurements updated during follow-up to assess the effect of weight, BMI on breast cancer risk.